Principal Care Management in Hawaii.
Focused management of a single high-complexity chronic condition. Medicare billing, Med-QUEST coverage, and compliance details for Hawaii providers.
How does PCM work for providers in Hawaii?
Principal Care Management (PCM) allows Hawaii providers to bill Medicare for focused management of a single high-complexity chronic condition using CPT codes 99424, 99425, 99426, 99427. Medicare covers PCM under the same framework as CCM. Med-QUEST provides partial supplementary coverage. Prevalent conditions like diabetes drive PCM demand across Hawaii. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 4+ major health systems including The Queen's Health System and Hawaii Pacific Health. Hawaii's dense urban healthcare market supports strong adoption of remote care programs.
Medicare Billing
PCM billing in Hawaii.
PCM uses federally standardized CPT codes with uniform reimbursement across Hawaii. Med-QUEST provides partial supplementary Medicaid coverage for dual-eligible patients.
PCM services, first 30 min of clinical staff time per month
Each additional 30 min of PCM clinical staff time
PCM services requiring physician/QHP, first 30 min/month
Each additional 30 min of PCM physician/QHP time
~$75-$115/mo per patient
30 minutes of clinical staff or physician time per month for management of a single high-complexity condition
Medicare covers PCM under the same framework as CCM. Med-QUEST provides partial supplementary coverage.
Billing Requirements
Patient must have a single high-complexity chronic condition
Condition requires frequent medication or treatment adjustment
Cannot be billed simultaneously with CCM (99490/99491)
Comprehensive care plan required for the principal condition
Patient consent required prior to billing
Hawaii Medicaid Supplement
Med-QUEST provides partial supplementary coverage — check current Med-QUEST fee schedules for dual-eligible PCM rates. Hawaii's telehealth parity law supports remote PCM delivery at equivalent reimbursement rates.
Regulatory Landscape
PCM compliance in Hawaii.
Beyond federal Medicare requirements, Hawaii has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Telehealth Parity
- *Hawaii has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits.
- *Hawaii was among the first states with telehealth parity. Med-QUEST covers remote monitoring comprehensively. Island geography makes telehealth essential.
Interstate Licensure
- *Hawaii is not currently a member of the Interstate Medical Licensure Compact. Providers delivering PCM services must hold a valid Hawaii medical license.
EHR Integrations
PCM-compatible EHRs.
Major Hawaii health systems like The Queen's Health System and Hawaii Pacific Health use EHR platforms that CCN Health integrates with. Each integration includes automated PCM documentation, billing, and clinical workflows.
PointClickCare
889 integration guides
ALIS
887 integration guides
Ethizo
240 integration guides
athenahealth
240 integration guides
Charm Health
240 integration guides
MatrixCare
240 integration guides
Epic
240 integration guides
August Health
240 integration guides
FAQ
PCM in Hawaii questions.
Hawaii's dense healthcare market and 4+ major health systems like The Queen's Health System and Hawaii Pacific Health create strong infrastructure for PCM adoption. Med-QUEST offers partial supplementary coverage for dual-eligible patients. High prevalence of diabetes, heart disease, hypertension among Hawaii's patient population drives PCM enrollment.
Med-QUEST provides partial supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. Med-QUEST provides partial supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Hawaii has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits. Hawaii was among the first states with telehealth parity. Med-QUEST covers remote monitoring comprehensively. Island geography makes telehealth essential.
Among Hawaii's 0.3M seniors, patients with a single high-complexity condition — such as uncontrolled diabetes or advanced heart disease — are prime PCM candidates. Hawaii's urban practices often identify PCM candidates through existing chronic disease registries. Hawaii's high Medicare Advantage penetration means many seniors are already enrolled in plans that support PCM.
Hawaii has approximately 0.3M residents aged 65+ (17.2% of the population), with +18% by 2035 projected growth. Island geography makes remote monitoring essential for inter-island care. High cost of healthcare drives telehealth adoption. Significant military and veteran population.
PCM in Hawaii must comply with federal Medicare billing requirements and HIPAA. Hawaii does not currently have a comprehensive state privacy law beyond HIPAA, but standard patient consent and data security requirements apply. Hawaii is not part of the Interstate Medical Licensure Compact — providers must hold a valid Hawaii license to deliver PCM services. Hawaii was among the first states with telehealth parity. Med-QUEST covers remote monitoring comprehensively. Island geography makes telehealth essential.
This page provides general informational guidance only and does not constitute legal, compliance, or billing advice. Telehealth regulations, Medicaid coverage, and state privacy laws change frequently. Verify current requirements with your state health department, payers, and qualified healthcare compliance counsel before making program decisions. Demographic data is based on U.S. Census Bureau estimates. Data last verified: March 2026.
Other Programs
More programs in Hawaii.
Explore other Medicare remote care programs available to Hawaii providers.
RPM
Remote Patient Monitoring
Real-time vital sign monitoring with FDA-cleared cellular devices.
CCM
Chronic Care Management
Non-face-to-face care coordination for patients with multiple chronic conditions.
BHI
Behavioral Health Integration
Behavioral health screening and collaborative care in primary care settings.
RTM
Remote Therapeutic Monitoring
Therapy outcome monitoring for musculoskeletal and respiratory rehabilitation.